Kern County Department of Agriculture and Measurement Standards

GENERAL INFORMATION

AGRICULTURAL PROTECTION

ENVIRONMENTAL PROTECTION

MEASUREMENT STANDARDS

Site Search:

County of Kern

Agriculture and Measurement Standards

county home > agriculture and measurement standards > forms and documents

All available forms and documents are arranged by Division and, except where noted, stored in Adobe pdf format. View pdf documents with Adobe Acrobat Reader. If your document is not listed please call (661)868-6300 or e-mail the Division Deputy to request a copy.

CONSUMER and AGRICULTURAL PROTECTION

Forms and Documents

Contact Deputy Director Cerise Montanio at: montanioc@kerncounty.com

GENERAL
INFORMATION REQUEST	Department form for requesting public records.

PHYTOSANITARY CERTS
CANADA ORIGIN CERTIFICATE	Canadian Food Inspection Agency Certificate of Origin for counties NOT regulated for LBAM (includes Kern County).

CDFA QUARANTINE COMPLIANCE CERT.	Certificate of origin and treatment (if applicable) for commodities shipped from or through Kern County.

REQUEST FOR INSPECTION - CITRUS	Notification form for pending treatments or request to inspect export products under special program requirements.

REQUEST FOR INSPECTION - GRAPES	Notification form for pending treatments or request to inspect export products under special program requirements.

REQUEST FOR INSPECTION - OTHER	Notification form for pending treatments or request to inspect export products under special program requirements.

PExD	Phytosanitary Export Databases.

PCIT
PCIT FACT SHEET	USDA Phytosanitary Certificate Issuance and Tracking (PCIT) System – Industry Fact Sheet.

USDA ADMIN FEE
CHECKS COLLECTED WORKSHEET	Log for tracking the USDA Administrative Fee remitted in check form (for shippers using 4-part paper).

PHYTOS ISSUED - WORKSHEET	Log for tracking Date, Applicant, and Certificate Number for issued Federal Phytosanitary Certificates (for shippers using 4-part paper).

USDA MEMO	USDA Administrative Fee announcement and information.

ENVIRONMENTAL PROTECTION

Forms and Documents

Contact Deputy Director Brian Gatza at: gatzab@kerncounty.com

FUMIGANT CONDITIONS
CHLOROPICRIN, Effective 1/1/24.	Includes NOI requirements, bed/broadcast/drip tarp buffer zone tables, Emergency Preparedness & Response Requirements and map.(Effective 1/1/24)

APPROVED TARPAULIN LIST	Includes all tarpaulins approved by DPR for Chloropicrin applications.

FIELD FUMIGATION MANAGEMENT PLAN	CA-DPR fillable pdf management plan for field fumigation (Form DPR-ENF-220).

FIELD FUMIGATION METHOD CODES	CA-DPR Volatile Organic Compounds (VOC) field fumigation codes for NOI's and PUR's.

FIELD FUMIGATION POST APPL. SUMMARY	CA-DPR fillable pdf field fumigation post-application summary (Form DPR-ENF-228).

METAM SODIUM/ POTASSIUM	Approved metam application methods, NOI requirements, and acceptable and prohibited times/locations. Includes the Kern County Fumigation Summary form.

NON FIELD FUMIGATION MANAGEMENT PLAN	Management plan for non-field fumigation.

1,3-D(TELONE)	Overview, application methods, and background information for 1,3-Dichloropropene pesticides (fumigants).

PERMIT - CONDITIONS


CHLORPYRIFOS	General conditions and buffer zone requirements around sensitive areas.

DRIFT MINIMIZATION	Aircraft and ground drift minimization measures for restricted materials.

GENERAL	Kern County General Permit Conditions.

GWPA - MANAGEMENT	Runoff and leaching management practices for Ground Water Protection Areas (GWPA). Includes pesticides subject to restriction and all classified Kern County GWP Areas (listed by TRS).

GWPA - NON-PRODUCTION	Supplemental conditions for GWP Area materials when used at non-production and/or non-agricultural sites (non-site specific use).

HERBICIDE DRIFT PREVENTION CONDITIONS	Kern County conditions to prevent herbicide drift.

PHENOXY	Allowed dates and restrictions for phenoxy applications.


PERMIT - GENERAL
LETTER OF AUTHORIZATION	Authorization for anyone other than the permittee (the operator of the property, defined as the owner, partner or officer of the business applying for the permit) to sign the permit.

PERMIT SUPPLEMENT	Application for a Restricted Materials Permit supplement.

ALTERNATIVES AND MITIGATIONS	Alternatives and Mitigations required for Restricted Material Permits Only.

PERMIT - RESPIRATORY PROGRAM

MEDICAL QUESTIONNAIRE	Questionnaire for completion by each respirator-wearing employee.

MEDICAL QUESTIONNAIRE SPANISH	Questionnaire for completion by each respirator-wearing employee. SPANISH VERSION

WRITTEN RESPIRATORY PROGRAM	Respirator selection, fit testing, training and evaluation for an organization's Written Work-Site Specific Procedures.

FIT TEST-TRAINING ATTACHMENT	Employee respirator assignment, fit test, training record, and consultation (Written Respiratory Protection Program - Attachment #1).

VOLUNTARY POSTING	Posting requirements for voluntary respirator use.

VOLUNTARY POSTING SPANISH	Posting requirements for voluntary respirator use. SPANISH VERSION

WORKSITES WITH IDLH	Supplemental program documentation for use of atmosphere-supplying respirators and work in IDLH atmospheres. (Written Respiratory Protection Program - Attachment #2).

MISCELLANEOUS
KERN COUNTY CROP REPORT FORMS	Kern County Crop Report Data Instructional Letter General Crops Page 1 --- General Crops Page 2 --- Grapes --- Nursery Stock

INFORMATION REQUEST	Environmental and Public Protection Division information request. Use for Restricted Materials Permit and use report data requests. Note: Permit and use report data may be directly downloaded from our website.

CA RESTRICTED MATERIALS IN TOP 10 MATERIALS APPLIED ON COMMODITIES IN AB617 BOUNDARY- 2021	CA Restricted Materials in Top 10 Materials Applied on Commodities in AB617 Boundary.

PESTICIDE HANDLER TRAINING RECORD	Form documenting requirements and completed training for individuals who work with pesticides.

PESTICIDE HANDLER TRAINING RECORD SPANISH	Form documenting requirements and completed training for individuals who work with pesticides. SPANISH VERSION

FIELDWORKER PESTICIDE SAFETY TRAINING RECORD	Form documenting requirements and completed training for individuals who work in treated fields.

FIELDWORKER PESTICIDE SAFETY TRAINING RECORD SPANISH	Form documenting requirements and completed training for individuals who work in treated fields. SPANISH VERSION

PESTICIDE HANDLER WRITTEN TRAINING PROGRAM	Pesticide Handler Written Training Program.

PESTICIDE HANDLER WRITTEN TRAINING PROGRAM SPANISH	Pesticide Handler Written Training Program.

PESTICIDE SAFETY	PSIS-1 Working Safely With Pesticides in Agricultural Settings SPANISH VERSION
INFORMATION SERIES	PSIS-2 Storing, Moving, and Disposing of Pesticides in Agricultural Settings SPANISH VERSION
	PSIS-3 Closed Mixing Systems, Water Soluble Packaging, and Enclosed Cabs in Ag Settings SPANISH
	PSIS-4 First Aid and Emergency Decontamination SPANISH VERSION
	PSIS-5 Protecting Yourself From Breathing Pesticides in Agricultural Settings SPANISH VERSION
	PSIS-6 Safety Rules for Minimal Exposure Pesticides in Agricultural Settings SPANISH VERSION
	PSIS-7 Washing Pesticide Work Clothing SPANISH VERSION
	PSIS-8 Safety Rules for Pesticide Handlers in Agricultural Settings SPANISH VERSION
	PSIS-9 Pesticide Safety Rules for Farmworkers SPANISH VERSION
	PSIS-10 Extra Medical Care for Handlers Who Use Organophosphates and Carbamates SPANISH VERSION


COMMON MATERIALS USED FOR SELECT COMMODITIES	Common Materials Used for Select Commodities.

REPORT OF LOSS	Environmental and Public Protection Division report of crop loss, nonperformance or damage.

PEST CONTROL RECOMMENDATION	Hand Written Pest Control Recommendation.

PRIVATE APPLICATOR CERTIFICATE REGULATORY UPDATES	Upcoming Regulatory Changes for Private Applicator Certificate.

BURROWING VERTEBRATE PEST FUMIGANT STUDY MANUAL	Burrowing Vertebrate Pest Fumigant (BVF) Study Manual.

BURROWING VERTEBRATE PEST FUMIGANT STUDY MANUAL SPANISH	Burrowing Vertebrate Pest Fumigant (BVF) Study Manual.(SPANISH)

MEASUREMENT STANDARDS

Forms and Documents

Contact Deputy Director Michelle SansSoucie at: sanssouciem@kerncounty.com

GENERAL
COMPLAINT FORM	Division form for reporting a business in violation of weights and measures standards.

CUSTOMER SATISFACTION SURVEY	Customer satisfaction survey for Measurement Standards complaints.

INFORMATION REQUEST	Department form for requesting public records.

DEVICES
DEVICE REGISTRATION APPLICATION	Application for Weights &/ Measures Device Registration.

CALIFORNIA TYPE EVALUATION PROGRAM	Application for evaluation of a new Weighing or Measuring Device(s).

PLACED IN SERVICE REPORT	Sample form for reporting placement after repair of a Commercial Weighing or Measuring Device.

SERVICE AGENCY APPLICATION	CDFA form for agencies registering to service Weights and Measures devices.

SERVICE AGENCY CANCELLATION FORM	CDFA form for agencies canceling their registration to service Weights and Measures devices.

METER-SCALE LOG FORM	Paperwork that accompanies meters or scales dropped off at Department for inspection and testing.

REQUEST FOR INSPECTION	Form used for owner to request inspection of commercial or non-commercial weighing or measuring devices.

MISCELLANEOUS
CONSUMER BROCHURE	CDFA Department of Measurement Standards consumer information brochure. Includes tips for the consumer and contact information.

WEIGHMASTER
COMMON TARE NOTICE	Notice of official tare and referenced weighmaster certificate number for posting at all weighing locations. Includes instructions.

WEIGHMASTER LICENSING	Application for a new, renewal or updated Weighmaster License. Includes instructions.

WEIGHMASTER LICENSE CANCELLATION	Form for canceling a Weighmaster License.

Last Modified
11/19/2024

Site Maintained by
agcomm@kerncounty.com

Website Usage Policy

Free Speech Policy